Artículos (Medicina)

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Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain
(JMIR Publications, 2019-04-01) Boceta Osuna, Jaime; Samper, Daniel; Torre, Alejandro de la; Sánchez de la Rosa, Rainel; González, Gloria; Medicina
Background: Breakthrough pain is a major problem and a source of distress in patients with cancer. We hypothesized that health care professionals may benefit from a real-time mobile app to assist in the diagnosis and monitoring of breakthrough cancer pain (BTcP). Objective: This study aimed to test the usability, acceptability, and usefulness in real-world practice of the mobile App INES·DIO developed for the management of patients with BTcP. Methods: This study consisted of a survey of a multidisciplinary sample of 175 physicians who evaluated the mobile app after testing it with 4 patients with BTcP each (for a total of 700 patients). The digital profile of the physicians, use of the different resources contained in the app, usefulness of the resources, acceptability, usability, potential improvements, intention to use, and additional resources to add were recorded. Results: Of the 175 physicians, 96% (168/175) were working in public hospitals. They had an average of 12 (SD 7) years of experience in BTcP and almost all (174/175, 99.43%) had an active digital profile. The Eastern Cooperative Oncology Group and Karnofsky performance scales, the Visual Analogue Scale, and the Davies algorithm to diagnose BTcP were the most frequently used tools with patients and were assessed as very useful by more than 80% (140/175) of physicians. The majority (157/175, 90%) answered that App INES·DIO was well designed and 94% (165/175) would probably or very probably recommend it to other colleagues. More than two-thirds indicated that the report provided by the app was worth being included in patients’ clinical records. The most valued resource in the app was the recording of the number, duration, and intensity of pain flares each day and baseline pain control to enhance diagnosis of BTcP. Additional patient-oriented cancer pain educational content was suggested for inclusion in future versions of App INES·DIO. Conclusions: Our study showed that App INES·DIO is easy to use and useful for physicians to help diagnose and monitor breakthrough pain in patients with cancer. Participants suggested the implementation of additional educational content about breakthrough pain. They agreed on the importance of adding new clinical guidelines/protocols for the management of BTcP, improving their communication skills with patients, and introducing an evidence-based video platform that gathers new educational material on BTcP.
Modelo de manejo multidisciplinar de catéteres permanentes tunelizados: resultados a 5 años
(2012-06-18) Cárcamo Baena, Jesús; Salgueira Lazo, Mercedes; Gómez Castilla, Antonia Concepción; Tienda Moreno, Marcos; Tienda Moreno, Marcos; Rico Castillo, Cándido; Pozuelo García, Inmaculada; Medicina
Pacientes en programa de hemodiálisis (HD) es uno de los retos más importantes a los que se enfrenta la Nefrología. El acceso vascular (AV) ideal es aquél que facilita un flujo adecuado para la diálisis, tiene una vida media prolongada y baja tasa de complicaciones. La fístula arterio-venosa (FAVI) autóloga es la que mejor cumple estas condiciones, tiene la menor tasa de infecciones y de trombosis y es la recomendada como primera opción siempre que sea posible. KDOQUI en el 2000, y su actualización en 2006, recomiendan el uso de FAVI como primera opción, considerando que debe ser el AV en al menos el 50% de los pacientes incidentes en HD, y el 65% en prevalentes. De igual forma desaconsejan el uso de Catéter Permanente Tunelizado (CPT), recomendando un porcentaje inferior al 10% de pacientes incidentes y limitando su uso a casos concretos Las guías de la SEN (enfermedad renal crónica avanzada y prediálisis 2008; de acceso vascular 2004) coinciden: la FAVi es la primera opción, cuando no sea posible se usará el AV protésico de PTFE y el catéter venoso central (CVC) es la última elección tras las dos anteriores. Son numerosas las publicaciones en los últimos años nos alertan sobre las consecuencias en términos de morbimortalidad y coste económico según el acceso vascular empleado en cada paciente. Así la FAVI se asocia con mayor supervivencia del paciente y menor coste, mientras que en el otro extremo son muchos los estudios que alertan sobre los efectos deletéreos en el pronóstico del paciente por la utilización de CVC. En nuestro país, el estudio MAR, estudio multicéntrico que incluyó más de 1700 pacientes ó el estudio del registro Andaluz de pacientes (2400 pacientes seguidos 4 años) concluyen que "La mortalidad en los pacientes con CPT o prótesis de PTFE es significativamente mayor que en los pacientes con FAVI" con supervivencia de los pacientes con FAVI de 73.7% y con CVC del 49%". Este efecto de los catéteres es independiente de la comorbilidad inicial del paciente.
Role of biological and non biological factors in congestive heart failure mortality: PREDICE-SCORE: A clinical prediction rule
(Via Medica, 2012-06-12) Gómez de la Cámara, Agustín; Guerra Vales, Juan Manuel; Magán Tapia, Purificación; Andrés Esteban, Eva; Vázquez Fernández del Pozo, Silvia; Calderón Sandubete, Enrique José; Medrano Ortega, Francisco Javier; Navarro Puerto, Asunción; Marín-León, Ignacio; PREDICE Group; Medicina
Background: Congestive heart failure (HF) is a chronic, frequent and disabling condition but with a modifiable course and a large potential for improving. The aim of this project was to develop a clinical prediction model of biological and non biological factors in patients with first diagnosis of HF that facilitates the risk-stratification and decision-making process at the point of care. Methods and Results: Historical cohort analysis of 600 patients attended at three tertiary hospitals and diagnosed of a first episode of HF according Framingham criteria. There were followed 1 year. We analyzed sociodemographic, clinical and laboratory data with potential prognostic value. The modelling process concluded into a logistic regression multivariable analysis and a predictive rule: PREDICE SCORE. Age, dependency for daily basic activities, creatinine clearance, sodium levels at admission and systolic dysfunction diagnosis (HF with left ventricular ejection fraction < 40%) were the selected variables. The model showed a c-statistic of 0.763. PREDICE Score, has range of 22 points to stratifications of 1-year mortality. Conclusions: The follow-up of 600 patients hospitalized by a first episode of congestive HF, allowed us to obtain a predictive 1 year mortality model from the combination of demographic data, routine biochemistry and easy handling social and functional variables at the point of care. The variables included were non-invasive, undemanding to collect, and widely available. It allows for risk stratification and therapeutical targeting and may help in the clinical decisions process in a sustainable way. (Cardiol J 2012; 19, 6: 578–585).
Ethical problems in the management of pain. Qualitative study through open reflection interview
(Aran Ediciones, 2020-04-17) Boceta Osuna, Jaime; Peiró-Peiró, A.; Cevas-Chopitea, F. J.; Vidal-Castro, L. M.; Acedo-Gutiérrez, M. S.; Mayoral-Rojals, V.; Bioethics working group in Spanish Pain Society (BioSED); Medicina
La práctica médica en el área del dolor plantea problemas éticos en la atención a pacientes con una enfermedad que provoca un deterioro funcional, con un pronóstico incierto para su reinserción laboral, y gran consumo de recursos familiares y sociales. Tras la creación de un grupo de trabajo en bioética dentro de la Sociedad Española del Dolor (SED) se intenta analizar dichos problemas. Objetivo: Conocer los problemas éticos relacionados con el manejo del dolor (práctica clínica, entorno e instituciones) que preocupan a los profesionales miembros de la SED, así como fomentar una reflexión ética. Metodología: Estudio cualitativo, basado en una entrevista semiestructurada, abierta, enviada a los miembros de la SED (n = 1035), mediante acceso electrónico, sobre 4 aspectos bioéticos: los problemas detectados en la práctica clínica, los problemas del entorno de trabajo, los problemas en las organizaciones de trabajo, y posibles sugerencias. Estos se agrupan según se refieran a las indicaciones (beneficencia y no maleficencia), la justicia (entendida como equidad) o la autonomía (información y preferencias). Resultados: Participaron en la entrevista un 6 % de los profesionales (n = 62/1035). Se elaboró un panel con las 10 cuestiones principales identificadas. Destacan la incertidumbre en la toma de decisiones en la terapéutica, la limitación del esfuerzo terapéutico, los condicionamientos del sistema sanitario, las relaciones con la industria farmacéutica y la búsqueda de la excelencia. Conclusiones: Este estudio cualitativo permite identificar problemas éticos que interesan a los profesionales dedicados al dolor. Es conveniente confirmarlos y dimensionarlos mediante estudios cuantitativos.
Role of Fibronectin in the Adhesion of Acinetobacter baumannii to Host Cells
(PLOS, 2012-04-13) Smani, Younes; McConnell, Michael J.; Pachón Díaz, Jerónimo; Medicina; Instituto de Biomedicina de Sevilla (IBIS); Ministerio de Ciencia e Innovación (MICIN). España; Instituto de Salud Carlos III; Spanish Network for Research in Infectious Diseases; Junta de Andalucía
Adhesion to host cells is an initial and important step in Acinetobacter baumannii pathogenesis. However, there is relatively little information on the mechanisms by which A. baumannii binds to and interacts with host cells. Adherence to extracellular matrix proteins, such as fibronectin, affords pathogens with a mechanism to invade epithelial cells. Here, we found that A. baumannii adheres more avidly to immobilized fibronectin than to control protein. Free fibronectin used as a competitor resulted in dose-dependent decreased binding of A. baumannii to fibronectin. Three outer membrane preparations (OMPs) were identified as fibronectin binding proteins (FBPs): OMPA, TonB-dependent copper receptor, and 34 kDa OMP. Moreover, we demonstrated that fibronectin inhibition and neutralization by specific antibody prevented significantly the adhesion of A. baumannii to human lung epithelial cells (A549 cells). Similarly, A. baumannii OMPA neutralization by specific antibody decreased significantly the adhesion of A. baumannii to A549 cells. These data indicate that FBPs are key adhesins that mediate binding of A. baumannii to human lung epithelial cells through interaction with fibronectin on the surface of these host cells.
Universal antifungal therapy is not needed in persistent febrile neutropenia: a tailored diagnostic and therapeutic approach
(Ferrata-Storti Foundation, 2012-03) Aguilar-Guisado, Manuela; Martín-Peña, Almudena; Espigado Tocino, Ildefonso; Ruiz Pérez de Pipaón, Maite; Falantes, José F.; de la Cruz, Fátima; Cisneros, José Miguel; Medicina; Instituto de Biomedicina de Sevilla (IBIS); Ministerio de Ciencia e Innovación (MICIN). España; Instituto de Salud Carlos III; Spanish Network for Research in Infectious Diseases; Spanish Network for Research in Infectious Diseases; Junta de Andalucía
Background: Giving antifungal therapy exclusively to selected patients with persistent febrile neutropenia may avoid over-treatment without increasing mortality. The aim of this study was to validate an innovative diagnostic and therapeutic approach based on assessing patients’ risk profile and clinical criteria in order to select those patients requiring antifungal therapy. The efficacy of this approach was compared to that of universal empirical antifungal therapy.Design and Methods: This was a prospective study which included all consecutive adult hematology patients with neutropenia and fever refractory to 5 days of empirical antibacterial therapy admitted to a teaching hospital in Spain over a 2-year period. A diagnostic and therapeutic approach based on clinical criteria and risk profile was applied in order to select patients for antifungal therapy. The sensitivity, specificity and negative predictive value of this approach and also the overall success rate, according to the same criteria of efficacy described in classical clinical trials, were analyzed.Results: Eighty-five episodes were included, 35 of them (41.2%) in patients at high risk of invasive fungal infections. Antifungal therapy was not indicated in 33 episodes (38.8%). The overall incidence of proven and probable invasive fungal infections was 14.1%, all of which occurred in patients who had received empirical antifungal therapy. The 30-day crude mortality rate was 15.3% and the invasive fungal infection-related mortality rate was 2.8% (2/72). The overall success rate following the diagnostic and therapeutic approach was 36.5% compared with 33.9% and 33.7% obtained in the trial by Walsh et al. The sensitivity, specificity and negative predictive value of the study approach were 100%, 52.4% and 100%, respectively.Conclusions: Based on the high negative predictive value of this diagnostic and therapeutic approach in persistent febrile neutropenia patients with hematologic malignancies or patients who have received a hematopoietic stem cell transplant, the approach is useful for identifying patients who are not likely to develop invasive fungal infection and do not, therefore, require antifungal therapy. The effectiveness of the strategy is similar to that of universal empirical antifungal therapy reported in controlled trials.
Chronic Elevation of Liver Enzymes in Acute Intermittent Porphyria Initially Misdiagnosed as Autoimmune Hepatitis
(Wiley, 2011-01-18) González Estrada, A.; García Morillo, José Salvador; Gómez Morales, L.; Stiefel García-Junco, Pablo Enrique; Medicina
Autoimmune hepatitis is a disease characterized by an elevation of liver enzymes, as well as specific autoantibodies. It is more common in women than men. We describe a 32-year-old woman with elevated transaminases, autoantibodies, and a liver biopsy result suggestive of autoimmune hepatitis. The indicated treatment was administered without showing a satisfactory response. The patient had a family history of acute intermittent porphyria (AIP) so we decided to begin treatment with hematin, achieving a complete remission of the symptoms. Acute intermittent porphyria is a rare condition characterized by neurovisceral symptoms, abdominal pain being the most common of them. The disease has a higher prevalence among young women and certain European countries such as Sweden, Great Britain, and Spain. A correct diagnosis and prompt treatment are essential because patients affected by AIP must have a strict followup due to the fatal outcome of the outbreaks.
Components of physical capacity in patients with chronic obstructive pulmonary disease: relationship with phenotypic expression
(Taylor & Francis Group, 2011-01-26) Márquez-Martín, Eduardo; Cejudo Ramos, Pilar; López-Campos Bodineau, José Luis; Serrano Gotarredona, María del Pilar; Navarro Herrero, Silvia; Tallón Aguilar, Rodrigo; Barrot Cortes, Emilia; Ortega Ruiz, Francisco; Medicina; Neumosur Foundation; Junta de Andalucía
Background: More accurate phenotyping of COPD is of great interest since it may have prognostic and therapeutic consequences. We attempted to explore the possible relationship between the extent of emphysema, as assessed by high-resolution computed tomography (HRCT), and COPD severity. We also included some study variables involving exercise tolerance evaluation and peripheral muscle strength (PMS) measurement. Methods: Sixty-four patients with COPD (mean age 64 ± 7 years) were enrolled in a prospective observational cross-sectional study. All patients underwent clinical and functional evaluations: assessment of dyspnea, body mass index (BMI), health status assessment, spirometry testing, and arterial blood gas analysis. The extent of emphysema was graded using HRCT. Functional capacity was evaluated by a cardiopulmonary maximal exercise testing (CPET), the shuttle walking test, and by estimation of PMS. Results: Half of the study patients had an emphysematous phenotype. There was a significant correlation between the score derived from analysis of HRCT images and BMI and respiratory functional parameters, as well as VO2 max (maximal oxygen uptake) and chest pull 1RM (1 rep max). Compared with subjects with a nonemphysematous phenotype, those with an emphysematous phenotype showed a lower BMI, a reduced PMS, and displayed a lower power at CPET. Significant differences in lung function tests were found for diffusing capacity and hyperinflation. No significant differences in quality of life were observed between the two study groups. Conclusions: Compared with subjects with a nonemphysematous phenotype, subjects with an emphysematous phenotype has a different profile in terms of BMI, lung function, PMS, and exercise capacity.
Plan de formación continuada en una unidad de gestión clínica
(Elsevier, 2011-10) Gamboa Antiñolo, Fernando Miguel; Bayol Serradilla, Elia; Gómez Camacho, Eduardo; Medicina
La Unidad de Continuidad Asistencial está orientada a la atención de pacientes frágiles, pluripatológicos y de cuidados paliativos. Atiende a pacientes en domicilio, consulta, unidad de día, consultoría telefónica y en dos hospitales de la misma área sanitaria. Desde su inicio en 2002 como unidad de gestión, la formación ha sido un elemento prioritario de desarrollo. Los elementos clave son acercar la formación al lugar de trabajo, incluir aspectos fundamentales de los problemas asistenciales más prevalentes en el trabajo diario, orientar la formación a todo el personal incluyendo aspectos organizativos, de seguridad del paciente y su entorno, mejora del clima laboral, desarrollo de nuevas habilidades y conocimientos apoyados en la asistencia basada en la evidencia para el desarrollo de las diferentes competencias profesionales. La unidad puede ser el escenario idóneo para acometer las necesarias reformas conceptuales de la formación de los profesionales que permitan mejorar la calidad asistencial.
Dyslipidemia as a long-term marker for survival in pulmonary embolism
(Taylor & Francis, 2011-09-30) Jara Palomares, Luis José; Otero Candelera, Remedios; Helías Hernández, Teresa; Cayuela Domínguez, Aurelio; Ferrer Galván, Marta; Alfaro, M. J.; Montero, E.; Barrot Cortés, Emilia; Medicina
Objectives: To analyse survival rate after 24 months in consecutive patients with a diagnosis of PE as well as associated factors. Methods: Prospective cohort study during a follow-up period of two years in a series of consecutive patients with PE. Results: During the follow-up period, 34 out of 148 patients died (23%). Factors independently associated with reduced survival rate were: creatinine levels > 2 (OR, 8.8; 95% CI, 1.1 - 70.87), previous neoplasm (OR, 8.8; 95% CI, 3.69 - 20.98), dementia (OR, 6.85; 95% CI, 2.1 - 22.33) and dyslipidemia (OR, 5.07; 95% CI, 1.92 - 13.44). Forty four percent of the patients with dyslipidemia died vs. 20.8% of patients without this condition. Conclusions: In our study dyslipidemia shows as a long-term negative prognostic marker for survival in patients with EP.
Development and validation of nomogram-based predictive models for severe hypoglycemia in adults with type 1 diabetes treated with multiple daily injections: the SEHYPAN study
(WILEY, 2026-03-06) Rodríguez de Vera Gómez, Pablo; Bellido, Virginia; Damas Fuentes, Miguel; Serrano Laguna, María del Carmen; Cózar León, María Victoria; Domínguez López, Marta; Martínez Brocca, María Asunción; Medicina
Background: Severe hypoglycemia is a major acute complication of type 1 diabetes (T1D) and is associated with increased morbidity, mortality, and impaired quality of life. Identifying individuals at the highest risk remains essential for optimising preventive strategies in real-world practice. Methods: The SEHYPAN (SEvere HYpoglycemia in ANdalusia) study was a multicenter case-control analysis including adults with T1D treated with multiple daily insulin injections (MDI). Cases were individuals who required pre-hospital emergency care for severe hypoglycemia between 2018 and 2022, each matched by sex, age, glucose-monitoring method (SMBG/isCGM), reference health-care area with controls who had not experienced severe events. Logistic regression models were used to identify independent predictors, and nomograms were generated for individualised risk estimation. Results: A total of 1464 participants were analysed (799 cases and 665 matched controls). Cases had longer diabetes duration, more comorbidities, and higher rates of smoking and alcohol use (all p < 0.001). Two nomogram-based models were developed: one for the overall cohort, including glucose monitoring modality, history of severe and nocturnal hypoglycemia, comorbid depression, alcohol use, and chronic conditions; and another specific to isCGM users, which also incorporated time in range and time below range. In the full cohort model, isCGM use was independently associated with lower odds of severe hypoglycemia. Both models showed good discrimination (AUC 0.75-0.83) and high sensitivity (≥ 0.75). Conclusions: The SEHYPAN study identifies key predictors of severe hypoglycemia in adults with T1D on MDI therapy. The innovative nomogram-based models provide personalised risk estimates that may enhance preventive care in everyday clinical practice.
Fe de errores de “Evaluación económica de rituximab en combinación con fludarabina y ciclofosfamida en comparación con fludarabina y ciclofosfamida en el tratamiento de la leucemia linfática crónica”
(2011-10) Casado, Luis Felipe; García Marco, José Antonio; Gilsanz, Florinda; González, Marcos; Ríos Herranz, Eduardo; De la Serna, Javier; Urbano, Álvaro; Vicente, Vicente; Rubio-Terrés, Carlos; Castro, Antonio J.; Medicina
En el artículo “Evaluación económica de rituximab en combinación con fludarabina y ciclofosfamida en comparación con fludarabina y ciclofosfamida en el tratamiento de la leucemia linfática crónica” (Gac Sanit. 2011;25:274–281) se ha detectado un error en la declaración de conflicto de intereses.
Evaluación económica de rituximab en combinación con fludarabina y ciclofosfamida en comparación con fludarabina y ciclofosfamida en el tratamiento de la leucemia linfática crónica
(Elsevier, 2011-08) Casado, Luis Felipe; García Marco, José Antonio; Gilsanz, Florinda; González, Marcos; Ríos Herranz, Eduardo; De la Serna, Javier; Urbano, Álvaro; Vicente, Vicente; Rubio-Terrés, Carlos; Castro, Antonio J.; Medicina; Roche Farma, S.A.
Objetivos: Evaluar el coste-efectividad del esquema de rituximab, fludarabina y ciclofosfamida (R-FC) en comparación con el de fludarabina y ciclofosfamida (FC) en dos tipos de pacientes con leucemia linfática crónica (LLC): no tratados previamente o bien en recidiva/resistentes al tratamiento previo. Métodos: Dos modelos de Markov, utilizando los resultados publicados de superviviencia libre de progresión (SLP) de pacientes con LLC tratados con R-FC o FC en primera o segunda línea, las tasas de progresión de la enfermedad y las tasas de mortalidad en España. A los estados de SLP y progresión se les asignaron utilidades obtenidas en un estudio sobre LLC. Los costes de los medicamentos y de los tratamientos de soporte, así como los años de vida ajustados por calidad (AVAC), se estimaron para un periodo de 10 años. Se efectuaron análisis de sensibilidad univariados y probabilísticos (Monte Carlo). Resultados: La adición de rituximab a la quimioterapia con FC aumentó los años de vida ganados (AVG) y los AVAC tanto en primera como en segunda línea de tratamiento. La razón de coste-eficacia incremental fue de 20.703 € por AVG y de 19.343 € por AVAC con la primera línea de tratamiento, y de 23.183 € por AVG y 24.781 € por AVAC con la segunda línea de tratamiento. Conclusiones: En los pacientes con LLC no tratados previamente y en aquellos en recaída o resistentes al tratamiento previo, la adición de rituximab al esquema FC aumentó la esperanza de vida y los AVAC, y en ambos casos resultó ser un tratamiento coste-efectivo.
Una década de progreso en la eliminación de la hepatitis C: desde el plan estratégico nacional a la inteligencia artificial
(Elsevier, 2026-06-11) Romero Otero, Sara; Lima da Silva, Lucas; Casado Martín, Marta; Villegas Portero, Román; Dopazo, Joaquín; Atienza Martín, Francisco J.; Espinosa Aguilera, Nuria Isabel; Romero Gómez, Manuel; Medicina
Impact of constitutional polymorphisms in VCAM1 and CD44 on CD34+ cell collection yield after administration of granulocyte colony-stimulating factor to healthy donors
(Ferrata Storti Foundation, 2011-01) Martín-Antonio, Beatriz; Carmona, Magdalena; Gil, Encarnación; Gil, Encarnación; Báez, Alicia; Suárez, María; Espigado Tocino, Ildefonso; Urbano Ispizua, Álvaro; Medicina; Instituto de Biomedicina de Sevilla (IBIS); Instituto de Salud Carlos III; RTICC (Red Temática de Investigación Cooperativa en Cáncer)
Background The number of CD34+ cells mobilized from bone marrow to peripheral blood after administration of granulocyte colony-stimulating factor varies greatly among healthy donors. This fact might be explained, at least in part, by constitutional differences in genes involved in the interactions tethering CD34+ cells to the bone marrow.Design and Methods We analyzed genetic characteristics associated with CD34+ cell mobilization in 112 healthy individuals receiving granulocyte colony-stimulating factor (filgrastim; 10 μg/kg; 5 days).Results Genetic variants in VCAM1 and in CD44 were associated with the number of CD34+ cells in peripheral blood after granulocyte colony-stimulating factor administration (P=0.02 and P=0.04, respectively), with the quantity of CD34+ cells ×106/kg of donor (4.6 versus 6.3; P<0.001 and 7 versus 5.6; P=0.025, respectively), and with total CD34+ cells ×106 (355 versus 495; P=0.002 and 522 versus 422; P=0.012, respectively) in the first apheresis. Of note, granulocyte colony-stimulating factor administration was associated with complete disappearance of VCAM1 mRNA expression in peripheral blood. Moreover, genetic variants in granulocyte colony-stimulating factor receptor (CSF3R) and in CXCL12 were associated with a lower and higher number of granulocyte colony-stimulating factor-mobilized CD34+ cells/μL in peripheral blood (81 versus 106; P=0.002 and 165 versus 98; P=0.02, respectively) and a genetic variant in CXCR4 was associated with a lower quantity of CD34+ cells ×106/kg of donor and total CD34+ cells ×106 (5.3 versus 6.7; P=0.02 and 399 versus 533; P=0.01, respectively).Conclusions In conclusion, genetic variability in molecules involved in migration and homing of CD34+ cells influences the degree of mobilization of these cells.
Outcome of pandemic H1N1 infections in hematopoietic stem cell transplant recipients
(Ferrata Storti Foundation, 2011-08) Ljungman, Per; de la Cámara, Rafael; Pérez-Bercoff, Lena; Abecasis, Manuel; Nieto Campuzano, José Bartolo; Cannata-Ortiz, M. Jimena; Espigado Tocino, Ildefonso; Engelhard, Dan; Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation (EBMT); Infectious Complications Subcommittee of the Spanish Group of Haematopoietic Stem-cell Transplantation (GETH); Medicina; Instituto de Biomedicina de Sevilla (IBIS)
During 2009, a new strain of A/H1N1 influenza appeared and became pandemic. A prospective study was performed to collect data regarding risk factors and outcome of A/H1N1 in hematopoietic stem cell transplant recipients. Only verified pandemic A/H1N1 influenza strains were included: 286 patients were reported, 222 allogeneic and 64 autologous recipients. The median age was 38.3 years and the median time from transplant was 19.4 months. Oseltamivir was administered to 267 patients and 15 patients received zanamivir. One hundred and twenty-five patients (43.7%) were hospitalized. Ninety-three patients (32.5%) developed lower respiratory tract disease. In multivariate analysis, risk factors were age (OR 1.025; 1.01–1.04; P=0.002) and lymphopenia (OR 2.49; 1.33–4.67; P<0.001). Thirty-three patients (11.5%) required mechanical ventilation. Eighteen patients (6.3%) died from A/H1N1 infection or its complications. Neutropenia (P=0.03) and patient age (P=0.04) were significant risk factors for death. The 2009 A/H1N1 influenza pandemic caused severe complications in stem cell transplant recipients.
Lineage dynamics and risk factors underlying serotype 4 invasive pneumococcal disease in Spain
(Oxford univ press, 2026-06-30) Pérez-García, Covadonga; Llorente, Joaquín; Aguirre Alastuey, María Elena; Llamosí, Mirella; Gil-Prieto, Ruth; Laghlali, Gabriel; El-Ayache, Farah; Cisneros, José Miguel; Yuste, José; Medicina
Background: The emergence of vaccine-covered serotypes causing invasive pneumococcal disease (IPD) is a serious concern worldwide. Methods: We characterized all national serotype 4 IPD isolates from children and adults received at the Spanish Pneumococcal Reference Laboratory (2009-24). Results: We investigated the unexpected rise of serotype 4 causing IPD in young adults after the COVID-19 pandemic, affecting elderly population in recent years. Epidemiological and genomic analysis confirmed that the rise started as an abrupt cluster of cases in Seville (Andalusia) in the year 2022 due to the ST15063 within GPSC12 lineage. This outbreak initially affected non-vaccinated young individuals associated with high rates of tobacco smoking, alcohol, and inhaled drugs followed by a general distribution through the country in the following years that affected adults ≥ 65 years old. Moreover, ST15063 serotype 4 strains displayed enhanced infection rates of human lung cells that significantly increased in the presence of cigarette smoke exposure and by influenza H3N2 coinfection. Conclusions: These findings highlight the need for targeted vaccination strategies, molecular surveillance, and focused interventions in high-risk populations.
Development of a Highly Specific RPA/CRISPR-Cas13a Assay for Detection of Pseudomonas aeruginosa Virulence Factor ExoU in Blood Samples
(MDPI, 2026-05-24) Ceballos-Romero, Lucía; Herrera Espejo, Soraya; Atassi, Daniel; Sánchez-Suero, Pilar; Pachón Díaz, Jerónimo; Cisneros, José Miguel; Pachón Ibáñez, María Eugenia; Medicina; Instituto de Biomedicina de Sevilla (IBIS); Subdirección General de Evaluación y Fomento de la Investigación; Instituto de Salud Carlos III; Ministerio de Ciencia e Innovación (MICIN). España; CIBER de Enfermedades Infecciosas (CIBERINFEC); European Development Regional Fund; SuDirección General de Redes y Centros de Investigación Cooperativa; Junta de Andalucía; “Nicolás Monardes” Researcher
Rapid detection of Pseudomonas aeruginosa and its virulence factor ExoU is essential for improving patient outcomes. In this study, a CRISPR–Cas13a-based diagnostic assay combined with recombinase polymerase amplification (RPA) was developed to detect P. aeruginosa and the exoU gene in blood samples. The assay demonstrated robust amplification, with detection limits of 6 log10 and 8 log10 CFU/mL in Luria–Bertani medium and blood, respectively, and a 100% specificity, without cross-reactivity against four Gram-negative bacilli and Staphylococcus aureus reference strains. The utilisation of a fluorescence-based readout facilitated unambiguous discrimination between P. aeruginosa and P. aeruginosa/exoU+ isolates vs. negative controls. In conclusion, these results support the potential of RPA/CRISPR-Cas13a diagnostics for the rapid identification of P. aeruginosa and its ExoU virulence factor. Further optimisation and clinical validation are required to confirm its utility as a bedside diagnostic test, where its application would speed up clinical decisions in the treatment of these infections.
β-Glucans, pneumocystis jirovecii and atherogenic inflammation: from pulmonary immunity to cardiovascular risk
(MDPI, 2026-06-14) Castillo, José C.; Iglesias, Enrique; Castillo, Johanna; Fonte, Luis; Aragón-López, Carlos E.; Cueto-Aragón, Claudia L.; Calderón Sandubete, Enrique José; Medicina
The interaction between Pneumocystis jirovecii and systemic inflammation has emerged as a potential modulator of cardiovascular risk. This review describes the potential of β-glucans to contribute to atherogenic inflammation. A narrative review was developed on the PubMed/MEDLINE, Scopus, Web of Science and Google Scholar databases. The inflammatory pathways induced by β-glucans from P. jirovecii contrast with the immunometabolic effects of dietary β-glucans. The relevance of serum (1→3)-β-D-glucans as a marker of systemic exposure was also described, although it is not specific to P. jirovecii. P. jirovecii β-glucans activate Syk–CARD9–NFκB, MAPK and STAT3 signalling pathways. This signalling promotes proinflammatory monocyte/macrophage polarization and a systemic microenvironment of low-grade inflammation with proatherogenic potential. The serum persistence of (1→3)-β-D-glucan indicates prolonged exposure, even in the absence of overt clinical manifestations of colonization. Conversely, dietary β-glucans have been observed to elicit regulatory effects facilitated by microbiota and metabolism. In experimental setting, a causal link has been established between fungal β-glucans and atherosclerosis. P. jirovecii β-glucans act as immunological mediators capable of amplifying pulmonary and systemic inflammation, constituting a possible modulator of cardiovascular risk. Distinguishing between fungal and dietary β-glucans is imperative for comprehending emerging mechanisms of vascular inflammation.
Chimeric antigen receptor (CAR) modified T Cells in acute myeloid leukemia: limitations and expectations
(Frontiers, 2024-04-17) Guijarro-Albadalejo, Betariz; Marrero-Cepeda, Cristina; Rodríguez-Arbolí, Eduardo; Sierro-Martínez, Belén; Pérez Simón, José Antonio; García Guerrero, Estefanía; Medicina; Instituto de Biomedicina de Sevilla (IBIS); Instituto de Salud Carlos III; Junta de Andalucía; European Union (UE); Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS)-TERAV; Ministerio de Ciencia e Innovación
Acute myeloid leukemia (AML) is an aggressive hematologic malignancy with a poor prognosis despite the advent of novel therapies. Consequently, a major need exists for new therapeutic options, particularly for patients with relapsed/refractory (R/R) AML. In recent years, it has been possible to individualize the treatment of a subgroup of patients, particularly with the emergence of multiple targeted therapies. Nonetheless, a considerable number of patients remain without therapeutic options, and overall prognosis remains poor because of a high rate of disease relapse. In this sense, cellular therapies, especially chimeric antigen receptor (CAR)-T cell therapy, have dramatically shifted the therapeutic options for other hematologic malignancies, such as diffuse large B cell lymphoma and acute lymphoblastic leukemia. In contrast, effectively treating AML with CAR-based immunotherapy poses major biological and clinical challenges, most of them derived from the unmet need to identify target antigens with expression restricted to the AML blast without compromising the viability of the normal hematopoietic stem cell counterpart. Although those limitations have hampered CAR-T cell therapy translation to the clinic, there are several clinical trials where target antigens, such as CD123, CLL-1 or CD33 are being used to treat AML patients showing promising results. Moreover, there are continuing efforts to enhance the specificity and efficacy of CAR-T cell therapy in AML. These endeavors encompass the exploration of novel avenues, including the development of dual CAR-T cells and next-generation CAR-T cells, as well as the utilization of gene editing tools to mitigate off-tumor toxicities. In this review, we will summarize the ongoing clinical studies and the early clinical results reported with CAR-T cells in AML, as well as highlight CAR-T cell limitations and the most recent approaches to overcome these barriers. We will also discuss how and when CAR-T cells should be used in the context of AML.

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